What It Took to Save a North Korean Defector's Life

SEOUL, South Korea—In late November, a 24-year-old North Korean soldier dashed across the demilitarized zone separating North from South Korea. He barely escaped with his life as his former comrades opened fire at his back. The medical team at Ajou University Trauma Center in Suwon, about 20 miles south of Seoul, had no idea who he was when less than 25 minutes later, a military helicopter bearing a badly wounded patient touched down outside. But they knew he was dying.

He was losing blood quickly, and a gunshot wound to his chest made it difficult for him to breathe. A split-second decision by an American medic to perform a needle thoracostomy, an emergency procedure that involves inserting a needle into the chest to relieve pressure on the lungs, probably saved his life.

“It’s a very basic life-saving procedure,” said Dr. John Cook Jong Lee, the head of the trauma center at Ajou, “But reading or writing and doing something is a totally different thing.”

The defector had to be treated for multiple gunshot wounds—but perhaps even more shocking were the large parasites the surgical team discovered as they tried to repair his intestines, which had been lacerated in multiple places by a bullet that also shattered the his pelvis. The defector survived.

The street-level helipad at Ajou, where the defector arrived. (Adam Serwer / The Atlantic)

Lee, who trained as a trauma surgeon at UC-San Diego, has devoted the past 15 years of his life to creating and maintaining what he calls an American-style trauma center, where he works closely with American military surgeons. Lee told me that he sees the center as a continuation not just of American and South Korean cooperation, but the personal relationship between his family and the U.S. Lee’s father was a soldier in the Korean war, and two of his uncles served alongside U.S. forces in Vietnam.

“My father was fully supported by Americans; my uncles participated in Vietnam as South Korean Marine officers,” said Lee, who is also a lieutenant commander in the South Korean Navy. “I was getting trained by Americans. Now I am doing my job with American soldiers stationed in South Korea. Is this not a great chain reaction?”

I spoke to Lee about the defector and his health at Lee’s office in the trauma center in Ajou. The office is decorated with photos of the hospital; many of them show him with American military officers, or feature American commendations, like the certificate he received from the White House physician in 2009 after a visit to South Korea from President Obama. A tall bookshelf in the middle of the room features a small black leather bible in front of massive tomes on trauma surgery. Behind the shelf lies a small, disheveled twin bed covered by an wrinkled brown blanket, where Lee sleeps four nights a week.

Lee walked me through the procedures he used to save the defector’s life, and spoke about how he handled his treatment. What follows is a condensed and edited transcript of our conversation.

Adam Serwer: Tell me about yourself. How did you end up examining the North Korean defector?

Cook Jong Lee: This trauma center was designed by American surgeons. I have been working with them as a part of their team since 2003. This is the only American-style trauma bay in South Korea. Whenever our service members, doctors, or crew members of the [the air medical evacuation team] or any kind of military officers first come into this trauma bay, they say it looks like America. It’s not that the South Korean trauma system is so superb to be able to save the North Korean. The reason we were able to save the North Korean’s life [is] just that I have been doing this job, not as a part of the South Korean military system, but as part of the American standout medical system.

Serwer: What kind of injuries did the defector have when you examined him?

Lee: He had at least five shots [to his body], coming from behind him. The inlets were in his back, and the outlets were in his front. One of the bullets came from the left side of his chest, so he had a tension pneumothorax [the gunshot wound had damaged his lung]. The staff sergeant overseeing put the needle thoracostomy in his shoulder and probably saved his life. Another bullet came through his buttock and shattered his pelvis and broke a lot of intestinal structures. Another bullet came from his right arm, [from] back to front, so he had a penetrating wound in his right arm. And another wound penetrated his knee as well. He was very fortunate it was not that deep. He had a huge amount of blood, and his intestinal space was totally contaminated, and to make matters worse he had the parasites.

Serwer: What do his pre-existing health problems say about life in North Korea?

Lee: He had hepatitis and parasites, but in terms of nutrition his status was not that bad. His hepatitis was not properly examined or treated in North Korea; when I asked him about [it] for the first time, he didn’t realize what hepatitis was. I heard [from him] there was no regular routine checkup [in North Korea] even for military guys.

Frankly speaking, I didn’t ask him anything about North Korea—it might remind him of bad feelings, it might affect his recovery. He was trying to tell me things about North Korean life; I’d tell him to be quiet. He was in pain after he woke up. From my point of view, he was not really depressed. If I were him I would be much more depressed. He was very energetic; he was very curious and positive. Ordinary North Koreans don’t flee into South Korea very easily, but he probably grew up [at] a more middle-class level.

Serwer: You think he was from a more important family?

Lee: Not important, but [he told me] his father’s rank was like a lieutenant colonel level.

Serwer: How do you get that many parasites?

Lee: I heard that it’s because in North Korea, they are using human fecal material as agricultural fertilizer. Parasites produce hundreds of eggs a day. So many eggs. So it comes out in the fecal material, and then North Koreans use it for fertilizer, for their farming system. So the soil is all contaminated with parasite eggs. Most developed countries don’t use human feces.

Dr. Lee’s office bookshelf. (Adam Serwer / The Atlantic)

Serwer: How did he survive being shot so many times in that kind of condition?

Lee: Our human body, we don’t have that much blood in our body. Five percent of our body weight consists of our blood. So a 70-kilogram [155-pound] adult human has only got 3,500 milliliters of blood [about a gallon]. People [are in danger of bleeding to death when] a little bit more [than] half of blood volume has leaked out. I was [getting information on] blood-loss status before he arrived; he was totally unconscious, and our dust-off team kept trying to give him fluid, to elevate his blood pressure, but his blood pressure was not powerful. He was unconscious, and his femoral pulse was not powerful. These two facts meant that he had lost more than 50 percent of his blood volume—he was going to die.

Serwer: So how did he survive?

Lee: Our dust-off team did a really great job. They were activated quickly, and they were able to get here in a very short period of time, less than 25 minutes. On the way here, because he had a gunshot wound on his chest, the patient couldn’t breathe properly. So he did a needle thoracostomy on him. It’s a very basic life-saving procedure, but reading or writing and doing something is a totally different thing. That’s why I am really proud of our service as part of the dust-off team.

The trauma team at Ajou performing a helicopter drill with a test dummy.

Serwer: How do those problems compare to issues you're used to treating from South Koreans?

Lee: I saw many hepatitis patients up to the 1990s, but now not so much. In terms of parasites, I’ve never seen such a huge amount of parasites in the intestine. His hepatitis was a unique type, it was B but also D, and D is really resistant to ordinary treatment.

He’s doing great now.

Serwer: Did the defector say anything to you about why he ran over?

Lee: His car was stopped, he was trying to drive his car to South Korean territory directly, but unfortunately his car was stopped.

Serwer: I mean do you know why he made the decision to defect?

Lee: No, I didn’t ask him. That might be stressful.

Serwer: What kind of questions did he ask you when he woke up?

Lee: Right after he woke up, he was disoriented, and he was yelling and shouting. A couple of hours later, he woke up again, and one of the first questions he asked me [was], “Is this really South Korea?” I hung the South Korean flag in front of his bed. So I actually asked him, hey, have a look at that flag, if you were in North Korea, you wouldn’t see that flag.

Lee: He didn’t like military movies, but he loves to drive—his speciality [in the military] was as a driver. So he was really interested in Transporter 3, with the fancy cars appearing there. He also watched, I forget the name, a funny movie, Jim Carrey and Morgan Freeman?

Lee: Yeah. He also loves to listen to South Korean K-pop, girls’ groups. Later he was interested in having a look at South Korean TV series. I didn’t even show him the South Korean news. A lot of the news channels were broadcasting his story, so it might [affect] his recovery. He was watching young-generation romantic TV miniseries, like your sitcoms—Friends-style sitcoms. He wasn’t really interested in tough stories.

Serwer: What happens to him now?

Lee: He’s being investigated by the South Korean intelligence agencies, like [the equivalent of] the CIA, and the military. There’s some sort of joint investigation group, that consists of South Korean-based intelligence officers, military officers, and South Korean national police, probably four or five South Korean government investigations involved.

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